Provider Demographics
NPI:1366612343
Name:SMITH, STEPHEN RUSSELL (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RUSSELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 E HIGH
Mailing Address - Street 2:SPRINGFIELD EMERGENCY PHYSICIANS INC.
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45501
Mailing Address - Country:US
Mailing Address - Phone:937-328-9301
Mailing Address - Fax:
Practice Address - Street 1:2615 E HIGH STREET
Practice Address - Street 2:SPRINGFIELD EMERGENCY PHYSICIANS INC.
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45501
Practice Address - Country:US
Practice Address - Phone:937-328-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50 . 002725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant